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Medical Examinations Performed Outside the United States


Medical examinations in the United States for citizenship can get very strict. If you are getting medical examinations done outside of the United States, what are the things that you should do?

According to 42 CFR 34.3(d) of the Code, the following are the important things to follow:

Additional medical screening and testing for examinations performed outside the United States.

  • HHS/CDC may require additional medical screening and testing for medical examinations performed outside the United States for diseases specified in §§ 34.2(b)(2) and 34.2(b)(3) by applying the risk-based medical and epidemiologic factors in paragraph (d)(2) of this section.
  • Such examinations shall be conducted in a defined population in a geographic region or area outside the United States as determined by HHS/CDC.
  • Additional medical screening and testing shall include a medical interview, physical examination, laboratory testing, radiologic exam, or other diagnostic procedure, as determined by HHS/CDC.
  • Additional medical screening and testing will continue until HHS/CDC determines such screening and testing is no longer warranted based on factors such as the following: Results of disease outbreak investigations and response efforts; effectiveness of containment and control measures; and the status of an applicable determination of public health emergency of international concern declared by the Director-General of the WHO.
  • HHS/CDC will directly provide medical examiners information about all applicable additional requirements for medical screening and testing and will post these at the following Internet addresses: and

What does the risk-based approach mean?

The Code provides for a risk-based approach. Specifically, it includes the following:

HHS/CDC will use the medical and epidemiological factors listed in paragraph (d)(2) of this section to determine the following:

  • Whether a disease as specified in § 34.2(b)(3)(ii) is a communicable disease of public health significance;
  • Which diseases in § 34.2(b)(2) and (3) merit additional screening and testing, and the geographic area in which HHS/CDC will require this screening.

Medical and epidemiological factors include the following:

  • The seriousness of the disease’s public health impact;
  • Whether the emergence of the disease was unusual or unexpected;
  • The risk of the spread of the disease in the United States;
  • The transmissibility and virulence of the disease;
  • The impact of the disease at the geographic location of medical screening; and
  • Other specific pathogenic factors that would bear on a disease’s ability to threaten the health security of the United States.

The risk-based approach means that not every person who wants to enter the United States would need to go through a medical examination. For example, a chest radiograph examination and the serologic testing are only needed for the following:

  • Applicants for immigrant visas;
  • Students, exchange visitors, and other applicants for non-immigrant visas are required by a U.S. consular authority to have a medical examination;
  • Applicants outside the United States who apply for refugee status;
  • Applicants in the United States who apply for adjustment of their status under the immigration statute and regulations.
  • Applicants are required by DHS to have a medical examination in connection with the determination of their admissibility into the United States.

This is also based on the limitations based on age and other factors. Take note of the limitations for applicants who are 15 years of age or older:

  • For applicants under 15 years of age, a chest radiograph examination if the applicant has symptoms of tuberculosis, a history of tuberculosis, or evidence of possible exposure to a transmissible tuberculosis case in a household or other enclosed environment for a prolonged period; and
  • For applicants 15 years of age and older, serologic testing for syphilis and other communicable diseases of public health significance as determined by the Director through technical instructions.

When is additional testing required?

If upon medical notification on the examination, the doctor assesses that there is a need to perform additional testing, the following provision from 42 CFR 34.3(e)(4) shall apply:

  • How and where performed. All chest radiograph images used in medical examinations performed under the regulations to this part shall be large enough to encompass the entire chest.
  • Chest x-ray, laboratory, and treatment reports. The chest radiograph reading and serologic test results for syphilis shall be included in the medical notification. When the medical examiner’s conclusions are based on a study of more than one chest x-ray image, the medical notification shall include at least a summary statement of findings of the earlier images, followed by a complete reading of the last image, and dates and details of any laboratory tests and treatment for tuberculosis.
  • Procedure for transmitting records. For aliens issued immigrant visas, the medical notification, and chest radiograph images, if any, shall be placed in a separate envelope, which shall be sealed. When more than one chest radiograph image is used as a basis for the examiner’s conclusions, all images shall be included. Records may be transmitted by other means, as approved by the Director.
  • Failure to present records. When a determination of admissibility is to be made at the U.S. port of entry, a medical hold document shall be issued pending completion of any necessary examination procedures. A medical hold document may be issued for aliens who:

(1) do not have a valid medical notification, if required;

(2) Have a medical notification that is incomplete;

(3) Have a medical notification that is not written in English;

(4) Are suspected to have an inadmissible medical condition.

  • The Secretary of Homeland Security, after consultation with the Secretary of State and the Secretary of Health and Human Services, may in emergency circumstances permit the medical examination of refugees to be completed in the United States.
  • All medical examinations shall be carried out following such technical instructions for physicians conducting the medical examination of aliens as may be issued by the Director. Copies of such technical instructions are available upon request to the Director, Division of Global Migration and Quarantine, Mailstop E03, HHS/CDC, Atlanta GA 30333.

A thorough medical examination is one of the things that every immigrant to the United States must abide by. There are a lot of other rules that you should take note of as this article series continues on the next one.

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The article that you have read is based on general applications of the law. It is not legal advice and it is not to be construed as any legal consultation with the firm. No client-attorney relationship is created when you read the articles we have provided.

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The post Medical Examinations Performed Outside the United States appeared first on Haque Legal.

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